Surgical Strike Out

We had a fitful night of sleep last night, so neither Yoko nor I were well rested when we set off for The Moffitt Cancer Center at 6:50 this morning. Our appointment was for 9 AM and we were required to check in by 8:30. We got to the place just on time.

Unlike our last trip up to Moffitt, we were in and out quickly. We met with Lary Robinson, who reviewed my most recent CT and Pet Scans with us, comparing these with the scans done in October. The conclusion, as I expected, is that, despite the tumor shrinkage, surgery is still NOT possible. Dr Robinson explained that the tumor goes from the right lung into the central chest and almost extends into the left lung. He said I was classified as Stage IIIA. However I would be Stage IIIB if the tumor went only a little further and entered my left lung as well.

The radiation and chemo have done as good a job shrinking the tumor as could be expected. In fact, the lung tumor by itself could be removed, but the part of the tumor involving a central chest lymph node can not be removed, making surgery altogether useless. The good news is that the shrinkage in my central chest relieved the superior vena cava, which was being closed off and might have done considerable damage. Robinson believes that consolidation chemo is the best course of treatment going forward and is currently my best chance for a cure.

Robinson explained that the removal of the right lung, if it could it be done, has a 30% mortality rate. I asked why the mortality rate was so high and the explanation I received is that the operation requires pinching off the bronchial tubes. In many cases, post-operative complications arise because radiated bronchial tubes do no heal well and a bronchial fistula (leakage) develops.

Actually, I spent a good part of the day yesterday researching and reading about the proposed procedure and the more I read, the more apprehensive I became -- ergo my sleeplessness. Besides the 30% chance of dying from the operation and loosing a lung, there would also be the possibility of loosing your voice entirely, having a heart attack or having other coronary problems. The procedure is also a very painful requiring a long (2 - 3 month) recovery period and there is no guarantee that you would enjoy a good quality of life following such a procedure. (Frankly, I am more afraid of pain and becoming disabled than I am of dying!)

There is also the possibility that the surgeon would get in there, decide it could not be done after all, and simply close me up. This would be the worst of all worlds because I would still suffer all the pain of the surgery with none of the benefits and have to go through all the recovery and rehab while at the same time postponing consolidation chemo! All in all, while having surgery might statistically give me the best long-term prospects, I feel confident we can beat the cancer without it. In fact, Dr. Robinson said I am just the kind of patient (young and healthy with good initial response) that is cured.

I asked Dr Robinson what kind of chemo he thought I should do. He did not have an opinion, but he spoke with a medical oncologist (Dr Williams) at Moffitt about my case and Dr Williams seemed to think that, given my good performance status (i.e. general good health) more of the same (taxol and cisplatin doublet) at double the dosages (400 mg) might be in order for the consolidation phase.

On our way home from Moffitt, Scott Lunin called to see what Lary had to say and I relayed all the above. Yoko and I will meet with Scott tomorrow to decide on the next steps. Scott has been thinking about what the treatment should be. He pointed out in our phone conversation that we don't know what treatment modality has had the positive effect on the tumor -- was it the radiation, the chemo, or the combination of both? There are different schools of thought on what the next step should be; some people advocate changing the chemicals used; others would argue for more of the same -- emptying both barrels, so to speak, on the cancer.

Emotionally I like the "empty both barrels" approach. The problem is that we have to fight this the cancer like a chess game -- thinking several moves ahead and not just making the emotionally satisfying decision. Scott points out that we should consider what our options will be if the cancer pops-up elsewhere down the road. If we use all our ammunition now Cisplatin/Taxol) there is the possibility that we won't be able to use it later (because of toxicity) or it won't be as effective (because the surviving cancer cells have adapted). This might lessen the chances of fighting future cancer. (On the other hand, if we unload on it now and kill every remaining cell, there would be less of a chance of tumors returning.) I would also argue that "other chemicals" (keep the cancer guessing approach) would always be there as a "Plan B."

Anyway, after tomorrow we will decide what the next steps should be. Scott is an excellent doctor and I am an excellent patient. Together we will figure out the best way forward. In the meantime, Yoko and I are planning our June trip to California for Paula's wedding and a September cruise in the Mediterranean. My plan is to be cancer free by April.